Safe injection facilities: compassionate or enabling?

Par Dan Delmar
le 4 septembre 2008

The ongoing debate over whether
or not to provide Montreal drug addicts with clean syringes and a safe place to
shoot up pits the tough love crowd against a more sympathetic, mothering
approach; long-term solutions versus short-term relief.

Quebec’s new health minister, Dr.
Yves Bolduc, scrapped a pilot project last month that would have seen a safe
injection facility (SIF) created in the city, similar to Vancouver’s InSite
centre. Injection drug users can walk into the centres, no questions asked, and
get high in sterile cubicles as trained staff keep a watchful eye on them.
Workers make sure there are no overdoses and that the addicts can leave on
their own two feet.

InSite has been able to operate
legally since 2003 because of an exemption granted to the organization by
Health Canada. The project was in response to an out-of-control addiction
problem in Vancouver’s Downtown Eastside, where an estimated 4,700 injection
drug addicts live. Montreal is home to roughly 12,000 addicts island-wide, 25
per cent of which are HIV-positive.

There is no denying that clean
needles will prevent the spread of HIV and Hepatitis C among drug users.
Opponents of SIFs are arguing two main points: The first being a lack of
research into the long-term effectiveness of the sites and the second is a more
ideological standpoint against the tolerance of unhealthy, criminal behaviour.

“There’s something very wrong
about it,” said Seychelle Harding, director of communications for Portage, a
nonprofit group of treatment facilities that specializes in substance abuse
problems. “I’m very happy the decision (by Bolduc) to have safe injection sites
was dropped. These sites are a way to meet people and network to get drugs.”

Portage’s philosophy is
incompatible with SIFs; a source higher up at the organization told The
Métropolitain that it’s simply a stop-gap measure that enables a dangerous
lifestyle and does not reduce the number of addicts on the street. Their
treatment, on the other hand, is said to reduce criminality and drug use by 95
per cent.

Harding did concede that the
sites “may be helpful for a highly marginalized population; a very small group
that can’t be treated.”

Federal health minister Tony
Clement used more polarizing language while addressing doctors at last month’s
Canadian Medical Association conference in Montreal.

“Is it ethical for health-care
professionals to support the administration of drugs that are of unknown
substance, purity or potency; drugs that cannot otherwise be legally
prescribed?” Clement said. “The supervised injection site undercuts the ethic
of medical practice and sets a debilitating example for all physicians and
nurses, both present and future in Canada.”

Clement’s critics have said that
failing to intervene as addicts contract life-threatening infections could also
be against a doctor’s code of ethics.

A combination of SIFs and
treatment could be one possible solution that would bridge the gap between
opposing forces in this debate. Research completed last year by the University
of British Colombia, Vancouver’s St. Paul's Hospital and the B.C. Centre for
Excellence in HIV/AIDS suggests that InSite has been “associated independently
with a 30 per cent increase in detoxification service use, and this behaviour
was associated with increased rates of long-term addiction treatment initiation
and reduced injecting at the SIF.”

Bolduc’s reasoning for abandoning
the project, initiated by his predecessor, was the lack of research available
on the effectiveness of SIFs. No plans for the health ministry to conduct their
own studies have been announced. Parti Québécois critics blasted Bolduc,
calling it a Conservative-style lesson in civic morality and a failure to
respond to the AIDS crisis. The PQ’s press conference last month was held at a
Gay Village park that is notorious for neighbourhood children stumbling upon
used syringes on the playground.